TPOAb Positivity during Pregnancy and Miscarriage: Independent Risk, Synergistic Mechanisms with SCH, and Intervention Strategies

doi:10.12280/gjfckx.20251241

Abstract

Abstract:

Miscarriage is a common complication during pregnancy with a high incidence and complex etiology. Thyroid peroxidase antibody (TPOAb) positivity serves as an independent risk factor for miscarriage. It can directly damage the placenta via mechanisms such as immune inflammation and oxidative stress, independent of thyroid function, ultimately leading to miscarriage. Furthermore, TPOAb positivity can induce subclinical hypothyroidism (SCH). When they coexist, a vicious cycle of immune damage and thyroid hormone insufficiency can significantly exacerbate the risk of miscarriage. Levothyroxine (L-T₄) is the primary medication for treating SCH during pregnancy. However, its efficacy in preventing miscarriage and improving live birth outcomes remains controversial, particularly in patients with isolated TPOAb positivity or mild SCH, where the benefits are unclear. The optimal timing of intervention and dosing regimen also require further optimization. Future research should focus on precise risk stratification and early intervention strategies to provide evidence-based medical support for clinical practice.

Key words: Thyroid peroxidase antibody, Subclinical hypothyroidism, Pregnancy, Abortion, spontaneous, Levothyroxine

HE Zeng-tiantian, YU Jian-nan, GAO Zhu-wei, LIU Yu, ZHANG Qian, WU Xiao-ke. TPOAb Positivity during Pregnancy and Miscarriage: Independent Risk, Synergistic Mechanisms with SCH, and Intervention Strategies[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 255-260.

Figures/Tables 1

References 36

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